Experiences of replantation and reconstruction in 1,430 cases of traumatic amputation of limbs, fingers, and toes over 40 years at Kumamoto Kinoh Hospital

Using medical and surgical records, we retrospectively reviewed 1,430 cases of amputated limbs and fingers/toes, including 977 replantations, over 40 years （April 1981-March 2021） at Kumamoto Kinoh Hospital. The compiled data revealed that amputations occurred more frequently in upper than in lower limbs, with affected sites being more often peripherally located, and more frequently in legs than in feet. Amputations more frequently involved fingers/toes than limbs, with finger amputations predominating （1,163 cases）. The most commonly affected finger was the forefinger, followed by the middle finger, ring finger, and thumb. However, finger amputations declined gradually over the period; by 2016, the rate had fallen to less than one third of that in 1981, when replantation began. Upper and lower arm amputations began declining in 2000 and 2006 respectively, without a decrease in hand amputations. Successful engraftment of replanted fingers exceeded 95％ during 1981-2000 and subsequently reached almost 100％; for toes, hands, and sites other than thighs （upper/lower arms, lower limbs, and feet）, the rates were 88％, 98％, and 100％ respectively. After unsuccessful toe replantation, subsequent reconstruction using a toe-to-finger or wrap-around flap （requiring minimum sacrifice at the donor site） method achieved 100％ success. Age at adult amputation ranged from 20 to 64 years; many childhood （＜9 years） amputations were also observed. Amputations occurred less often on Sundays than on other days, and more often during the 9:00-17:00 period. The main causes were machinery in factories or on construction sites, followed by power saws and agricultural machinery. In Kumamoto Prefecture, agriculture and forestry accounted for almost twice the number of amputations occurring in factories, reflecting the local predominance of the former industries.